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Abstrak :
Latar belakang: Rekomendasi Centers for Disease Control and Prevention (CDC) 2010 (revisi 2002) tidak spesifik memberi panduan dalam pencegahan sekunder sepsis awitan dini (SAD) pada neonatus cukup bulan (NCB), asimtomatik lahir dari ibu yang mengalami KPD < 18 jam. Tujuan: Didapatnya model determinan SAD pada NCB sesuai masa kehamilan (SMK), asimtomatik lahir dari ibu yang mengalami KPD lebih dari 12 jam. Metodologi: penelitian observasional potong lintang untuk mendapatkan model determinan sepsis neonatorum awitan dini (SNAD) yang dilakukan dari Februari 2013 sampai bulan Mei 2014 di RSAB Harapan Kita, RSUD Tarakan, RSIA Budi Kemuliaan. Determinan yang diteliti adalah jenis persalinan, petanda infeksi saluran kemih (ISK) pada ibu, petanda infeksi intra amnion (IIA) seperti demam intrapartum, ibu takikardia, janin takikardia, adanya perubahan warna dan bau cairan ketuban, leukosit darah ibu, dan petanda infeksi darah tali pusat (peningkatan jumlah total leukosit, neutrofil, peningkatan rasio I/T, hs-CRP dan IL-6). Diagnosis sepsis ditegakkan berdasarkan catatan medis bayi yang dipastikan berdasarkan hasil positif biakan darah tali pusat. Model determinan SNAD yang dihasilkan adalah suatu persamaan regresi logistik yang digunakan untuk menentukan probabilitas terjadinya SNAD sebagai acuan terapi antibiotik. Hasil: model determinan SAD pada NCB SMK, asimtomatik lahir dari ibu KPD > 12 jam berupa kalkulator dan sistem skor yang dibentuk dari determinan persalinan per vaginam, perubahan warna dan bau cairan ketuban, leukosit darah ibu, leukosit darah tali pusat, kadar hs-CRP darah tali pusat dan kadar IL-6 darah tali pusat. Model determinan SNAD memiliki dua varian, varian lengkap digunakan untuk fasilitas pelayanan neonatus subspesialistik dan varian alternatif digunakan untuk fasilitas pelayanan spesialistik. Titik potong ideal penentuan probabilitas terjadinya SNAD memiliki sensitivitas di antara 24,2 – 40,3 % dan spesifisitas 87,1 - 94,5 %. Nilai diskriminasi dengan nilai AUC berkisar di antara 0,743 – 0,816 dengan kalibrasi baik berdasarkan uji Hosmer-Lemeshow. Simpulan: Hasil penelitian ini adalah model determinan SAD pada NCB SMK asimtomatik lahir dari ibu yang mengalami KPD > 12 jam, berbentuk kalkulator dan sistem skor yang memiliki varian lengkap dan alternatif untuk menentukan probabilitas terjadinya SNAD sebagai dasar pemberian terapi antibiotik empiris secara rasional. ......Background: Centers for Disease Control and Prevention (CDC) 2010 (revised 2002) recommendations does not specifically provide guidance in secondary prevention of asymptomatic early-onset sepsis (EOS) on term infant born to mother experiencing PROM < 18 hours. Objective: to develop early-onset neonatal sepsis (EONS) determinant model as a rational basis for determining the empirical antibiotic therapy in asymptomatic, term infant born to mother with PROM > 12 hours. Method: A cross-sectional observational study to obtain an EONS determinant model which was conducted from February 2013 to May 2014 in RSAB Harapan Kita, Tarakan Hospital, RSIA Budi Kemuliaan. The determinant factor is the type of delivery, marker of maternal urinary tract infection (UTI), intra-amniotic infection markers (intrapartum fever, maternal tachycardia, fetal tachycardia, change in the color and odor of amniotic fluid, maternal blood leukocytes), and umbilical cord blood infection marker (increased the total number of leukocytes, neutrophils, an increase in the ratio of I / T, hs-CRP and IL-6). Early-onset neonatal sepsis was diagnosed base on infant medical record on 72 hours afeter birth and confirmed by the positive results of umbilical cord blood cultures. The resulting of EONS determinants model is a logistic regression equation used to determine the probability of the occurrence of EONS as reference rational basis empirical antibiotic therapy. Results: The EOS determinants model on asymptomatic term infant born to mothers with PROM> 12 hours is a calculator and scoring system that is formed from the determinant of vaginal delivery, change the color and odor of amniotic fluid, maternal blood leukocytes, cord blood leukocytes, the levels of hs-CRP and IL-6 umbilical cord blood level. Early-onset neonatal sepsis determinant model has two variants, the full variant used for subspecialty neonatal care facilities and alternative variant is used for specialty neonatal care facilities. Ideal cutoff point probability of occurrence SNAD has sensitivity range of 24.2 to 40.3% and specificity of 87.1 to 94.5%. The model performe is good based on Hosmer-Lemeshow test anda discrimination value AUC in in range of 0.743 to 0.816. Conclusion: The EOS determinant model of asymptomatic term infant born to mothers with PROM > 12 hours is a calculator and scoring system that is used to determine the probability of EONS occurrence as the basis of determining the rational empirical antibiotic therapy.

Abstrak :
Tesis ini membahas perubahan kadar serum gamma glutamil transpeptidase GGT pada bayi dengan sepsis neonatorum. Penelitian ini merupakan suatu penelitian prospektif, yang dilakukan di ruang perawatan intensif bayi di Rumah Sakit Cipto Mangunkusumo. Pada hasil penelitian didapatkan bahwa kadar serum GGT tidak mempengaruhi luaran bayi dengan sepsis. Simpulan penelitian ini bahwa kadar GGT yang diambil pada bayi dengan sepsis, baik saat awal terdiagnosis sepsis sampai hari ketujuh, tidak mempengaruhi luaran baik dan buruk bayi. Kadar leukosit, trombosit, CRP dan bilirubin direk mempengaruhi luaran bayi dengan sepsis. ......This study discusses changes in serum levels of Gamma Glutamyl Transpeptidase GGT in infants with neonatal sepsis. This study is a prospective study, conducted in theNeonatal Intensive Care Unit NICU at Cipto Mangunkusumo Hospital. The resultsshowed that serum levels of GGT did not affect the outcome of infants with neonatalsepsis.The conclusion of this study is that the serum levels of GGT taken from infants with sepsisboth initially after the diagnosis of sepsis is established or until the seventh day, did notaffect the outcomes of neonatal sepsis. White blood cells, platelet, CRP and directbilirubin levels affect the outcome of infants with sepsis.

Abstrak :
Latar belakang: Sepsis neonatorum awitan lambat SNAL , merupakan penyebab morbiditas dan mortalitas terpenting bayi berat lahir rendah di rumah sakit. Klinisnya tidak spesifik sehingga membutuhkan pemeriksaan penunjang untuk mendiagnosisnya. Baku emas kultur darah memiliki nilai diagnostik yang rendah dan hingga kini belum ada penanda infeksi tunggal yang dapat mendiagnosis sepsis neonatorum. Toll-like receptor TLR berperan dalam mengenali patogen dan memulai respon imun. Ekspresi TLR2 dan TLR4 diharapkan dapat menjadi penanda sepsis neonatorum. Tujuan: Mengetahui ekspresi TLR2 dan TLR4 neutrofil dan monosit serta nilai diagnostiknya pada SNAL. Metode: Studi potong lintang pada Mei-Juni 2017 yang melibatkan 52 neonatus >72 jam dengan klinis sepsis. Pemeriksaan darah perifer lengkap, rasio I/T, CRP, PCT, TLR2 dan TLR4 menggunakan flow cytometry dilakukan dan dibandingkan dengan kultur darah. Hasil: Insidens SNAL penelitian ini sebesar 32,6 . Terdapat penurunan ekspresi TLR2 neutrofil maupun monosit pada kasus SNAL. Peningkatan ekspresi TLR4 neutrofil memiliki sensitivitas 88,2 , spesifisitas 20 , dan AUC 0,541. Ekspresi TLR4 monosit memiliki sensitivitas 92,1 , spesifisitas 11,4 , dan AUC 0,528 jika dibandingkan kultur darah. Nilai AUC CRP meningkat hingga lebih dari 0,75 setelah dikombinasikan dengan TLR4. Simpulan: Pada SNAL, ekspresi TLR4 memiliki sensitivitas yang baik namun kurang spesifik. Pemeriksaan TLR4 dapat menunjang nilai diagnostik CRP. ......Background Late onset neonatal sepsis LONS , is the major morbidity and mortality in low birth weight. Unspecific clinical manifestation make laboratory examination is needed to establish the diagnosis. Unfortunately, blood culture as a gold standard has low diagnostic value. While, there is no single infection marker to diagnose neonatal sepsis. TLRs are a sensor to recognize the pathogens and trigger the immune response. Expression of TLR2 and TLR4 are promising to be a septic marker. Aim To know the expression of TLR2 and TLR4 neutrophil and monocyte and their diagnostic value in LONS. Methods A cross sectional study was conducted from May June 2017 which involved 52 neonates 72 hours with clinically sepsis. Complete blood count, I T ratio, CRP, PCT, TLR2 and TLR4 by flow cytometry already done and compared to blood culture. Result The incidence of LONS is 32.6 . There is TLR2 down expression in LONS. Expression of TLR4 neutrophil has sensitivity 88.2 , specificity 20 , and AUC 0.541. While TLR4 monocyte has sensitivity 92.1 , specificity 11.4 , and AUC 0.528. AUC of CRP is increased over to 0.75 after combined with TLR4. Conclusion Expression of TLR4 have good sensitivity but less specific. TLR4 expression could increase the diagnostic value of CRP.

Abstrak :
Latar Belakang: Ketuban Pecah Dini KPD merupakan kejadian yang berhubungan dengan risiko tinggi morbiditas dan mortalitas baik pada maternal maupun perinatal. KPD terjadi pada 5-10 dari seluruh kehamilan dan insiden infeksi selaput ketuban bervariasi dari 6-10 . Berdasarkan data SDKI tahun 2007, AKI di Indonesia sebesar 228/100.000 kelahiran hidup, serta hasil studi epidemiologi oleh WHO dan UNICEF pada tahun 2010 didapatkan bahwa terdapat 7,6 juta kasus kematian anak < 5 tahun, di mana 64 4,879 juta terjadi karena infeksi, dan 40,3 3,072 juta terjadi di neonatus. Belum diketahui hubungan antara lama ketuban pecah, usia kehamilan, dan jumlah periksa dalam pada kasus KPD terhadap kejadian sepsis neonatorum di Indonesia. Tujuan: Studi ini bertujuan untuk mengetahui hubungan antara lama ketuban pecah, usia kehamilan, dan jumlah periksa dalam pada ibu hamil yang mengalami KPD dengan kejadian sepsis neonatorum, sehingga dapat menjadi dasar untuk evaluasi Standar Pelayanan Medik SPM KPD di Rumah Sakit Cipto Mangunkusumo RSCM. Metode: Penelitian ini menggunakan desain studi deskriptif analitik, dilaksanakan di RSCM Jakarta pada bulan Desember 2016 ndash; Juni 2017. Populasi pada penelitian ini adalah semua ibu hamil dengan usia kehamilan >20 minggu yang mengalami KPD dan tidak mempunyai penyulit seperti diabetes melitus ataupun penyakit sistemik serius seperti penyakit jantung atau autoimun, beserta dengan bayinya. Hasil: Terdapat 405 ibu hamil dengan KPD yang diikutsertakan dalam penelitian ini. Didapatkan 21 kasus 5.2 sepsis neonatorum. Hasil analisis menunjukkan bahwa lama ketuban pecah sampai dengan masuk RS ge; 18 jam dengan OR 3,08, lama ketuban pecah selama perawatan di RS ge; 15 jam dengan OR 7,32, dan lama ketuban pecah sampai dengan lahir ge; 48 jam dengan OR 5,77 mempunyai risiko yang lebih tinggi terhadap kejadian sepsis neonatorum. Usia kehamilan preterm < 37 minggu mempunyai risiko yang lebih tinggi terhadap kejadian sepsis neonatorum dengan OR 18,59. Sedangkan jumlah periksa dalam pada penelitian ini tidak dapat dianalisis. Kesimpulan: Lama ketuban pecah yang makin panjang serta usia kehamilan preterm mempunyai risiko yang lebih tinggi terhadap kejadian sepsis neonatorum. ...... Background: Premature Rupture of Membrane PROM is associated with high maternal as well as perinatal morbidity and mortality risks. It occurs in 5 to 10 of all pregnancy while incidence of amniotic membrane infection varies from 6 to 10. Based on the 2007 National Demography and Health Survey SDKI, Maternal Mortality Rate MMR in Indonesia is 228 per 100.000 live births. Results of epidemiological studies by the WHO and UNICEF in 2010 found that there were 7.6 million cases of under five mortality, in which 64 4.879 million occurred due to infection and the rest 40.3 3.072 million occurred in neonates. However, there is no known association between prolonged rupture of membrane, gestational age, and number of vaginal examination in PROM cases on neonatal sepsis incidence in Indonesia. Objectives: This study aims to find out the association between prolonged rupture of membrane, gestational age, and number of vaginal examination in pregnant women with PROM on neonatal sepsis incidence. The result may provide the basis for evaluating Standards of Medical Care SPM in PROM cases at Cipto Mangunkusumo Hospital RSCM. Methods: A hospital based analytical descriptive study was done in Cipto Mangunkusumo Hospital, Jakarta from December 2016 until June 2017. The study used total sampling method which included all pregnant women with gestational age of more than 20 weeks who experienced PROM and their babies. Samples with existing comorbidities such as diabetes mellitus or other serious systemic illnesses such as heart disease or autoimmune condition were excluded in the analysis. Results: A total of 405 pregnant women with PROM were incuded in this study. There were 21 cases 5.2 of neonatal sepsis. The analysis showed that risk of neonatal sepsis was higher in pregnant women with prolonged rupture of membrane for 18 hours before hospital admisission OR 3.08, prolonged rupture of membrane for 15 hours during hospitalization OR 7.32 , and prolonged rupture of membrane for 48 hours until birth OR 5.77. The risk of neonatal sepsis was even higher in preterm pregnancy with gestational age of <37 weeks (OR 18.59). However, the number of vaginal examination could not be analyzed. Conclusion: Risk of neonatal sepsis is higher in longer duration of prolonged rupture of membrane as well as preterm pregnancy.

Abstrak :
Latar Belakang: Sepsis neonatarum awitan dini (SNAD) mempunyai gejala klinis dan hasil laboratorium yang tidak spesifik sehingga diagnosisnya sulit ditegakkan, perlunya penelitian tentang faktor-faktor risiko ibu dan bayi yang mempengaruhi kejadian SNAD untuk diterapkan di fasilitas-fasilitas kesehatan terbatas. Tujuan: Mengetahui insiden pada sepsis neonatarum awitan dini,dan faktor-faktor risiko ibu dan bayi yang berpengaruh terhadap kejadian sepsis neonatarum awitan dini. Metode: Penelitian ini merupakan studi prognostik dengan desain kohort prospektif menggunakan data primer dari observasi dan data sekunder dari rekam medik pada bulan Juli-Oktober 2019 di Unit Perinatologi, Departemen Ilmu Kesehatan Anak Rumah Sakit Umum Cipto Mangunkusumo Jakarta, Indonesia. Bayi dengan gejala klinis, disertai faktor risiko ibu (suhu ibu, leukosit darah ibu, ketuban pecah dini, karakteristik ketuban, dan antibiotik intrapartum), dan faktor risiko bayi (skor APGAR, usia gestasi, berat badan lahir) dengan hasil positif SNAD (Proven: kultur darah +, Probable: >2 septic marker + dan kultur darah-). Sebanyak 120 subyek tersangka SNAD yang dilakukan analisis. Hasil: Hasil analisis multivariat faktor risiko ibu dan bayi dengan regresi logistik ganda adalah ketuban berwarna hijau, kental dan berbau (P=0,009, RR=839,9, IK 95% 0,000-1094,9), skor APGAR <7 (P=<0,001, RR=13,06, IK 95% 3,837-44,486), usia gestasi <37 minggu (P=0,002, RR=9,47, IK 95% 2,29-39,06), serta leukosit darah ibu >15000/µL (P=0,010, RR=4,44, IK 95% 1,420-13,915). Insidens SNAD pada penelitian ini adalah 87 dari 495 kelahiran (probable sepsis 86 per 495 dan proven sepsis 1 per 495). Kesimpulan: Faktor risiko ibu dan bayi terhadap kejadian sepsis neonatarum awitan dini berdasarkan hasil analisis multivariat adalah ketuban berwarna hijau, kental dan berbau, skor APGAR <7, usia gestasi <37 minggu, serta leukosit darah ibu >15.000/µL. ...... Background: Early-onset neonatal sepsis (EONS) has non-specific clinical symptoms and laboratory results, thus the diagnosis is difficult to establish. It is important to evaluate maternal and infant risk factors for EONS, for prediction of sepsis in limited healthcare facilities. Objective: To evaluate the incidence of early-onset neonatal sepsis, and maternal and infants risk factor of early-onset neonatal sepsis. Method: This is a prognostic study with prospective cohort design using primary data obtained from observations and secondary data from the Perinatology Division medical record in July-October 2019, Cipto Mangunkusumo Hospital Jakarta, Indonesia. Data of infants with clinical symptoms, accompanied by maternal risk factors (maternal temperature, maternal leukocytes, premature rupture of the membranes, amniotic characteristics, and intrapartum antibiotics), and infant risk factors (APGAR score, gestational age, birth weight,) with positive EONS results (Proven: blood culture +, Probable: >2 septic marker + and blood culture -) were taken. A total of 120 subjects with EONS events were analyzed. Results: Multivariate analysis with multiple logistic regression, significant maternal and infant risk factors were green, thick and foul odor of amniotic fluid (P=0.009, RR=839.90, CI 95% 0.000-1094.9), APGAR score <7 (P=<0.001, RR=13.06, CI 95% 3.83-44.486), gestational age <37 weeks (P=0.002, RR=9.47, CI 95% 2.29-39.06), and maternal leukocytes >15000/µL (P=0.010, RR=4.44, CI 95% 1.420-13.915). The incidence of SNAD in this study was 87 of 495 births (probable sepsis 86 per 495 and proven sepsis 1 per 495). Conclusion: Significant maternal and infant risk factors for the occurrence of early-onset neonatal sepsis are gestational age <37 weeks, APGAR score <7, green, thick and foul odor of amniotic fluid, and maternal leukocytes>15,000/µL.

Abstrak :
Latar Belakang:. Sepsis neonatorum awitan dini masih menjadi penyebab kesakitan dan kematian yang utama pada neonatus, dengan angka lebih tinggi terjadi pada bayi kurang bulan. Berbagai faktor diketahui berhubungan dengan kejadian sepsis neonatorum awitan dini, namun penelitian yang dilakukan pada bayi prematur masih terbatas. Tujuan:. Mengetahui faktor-faktor risiko yang berhubungan dengan kejadian sepsis neonatorum awitan ini pada bayi kurang bulan di RSCM. Metode:. Penelitian desain case-control dengan mengambil data dari rekam medis bayi lahir kurang bulan di RSCM pada rentang waktu Januari 2016-Desember 2017 sebanyak 186 sampel (93 untuk masing-masing kelompok). Data dianalisis secara bivariat dan multivariat. Hasil: Terdapat perbedaan bermakna dari karakteristik bayi kurang bulan antara kelompok kasus dan kontrol yaitu usia gestasi, jenis kelamin laki-laki, dan berat lahir. Gejala klinis tersering ditemukan adalah sesak napas. Dari 7 faktor yang dianalisis, infeksi intrauterin, nilai APGAR 1 menit pertama, dan nilai APGAR 5 menit pertama pada analisis bivariat dimasukkan ke analisis multivariat (p<0,25) sementara pada faktor lainnya tidak ditemukan hubungan yang bermakna. Pada analisis multivariat, ditemukan bahwa jenis kelamin laki-laki, usia gestasi, infeksi intrauterin, dan nilai APGAR 1 menit pertama memiliki hasil yang bermakna secara statistik. Kesimpulan: Jenis kelamin laki-laki, usia gestasi, infeksi intrauterin, dan nilai APGAR 1 menit pertama merupakan faktor risiko independen sepsis neonatorum awitan dini pada bayi kurang bulan. Penelitian lebih lanjut dibutuhkan untuk mengetahui pengaruh faktor-faktor tersebut terhadap kejadian sepsis neonatorum awitan dini pada bayi kurang bulan. ...... Background: Early onset neonatal sepsis is still considered as a common cause of morbidity and mortality in neonates, with a higher prevalence found in preterm infants. Many factors are known to be correlating to the cases of early onset neonatal sepsis, but research done specifically in preterm infants is limited. Objective: To determine the factors associated with early onset neonatal sepsis in preterm infants. Method: This research was done using a case-control design, where the data is taken from the medical record of preterm patients born in RSCM within January 2016-December 2017. The total sample is 186 (93 for each group). Data was then analyzed using bivariate and multivariate analysis. Result: A significant result was found in characteristic such as gestational age, gender, and birth weight. Out of 7 factors that were analysed, the factors that were analysed using multivariate analysis were intrauterine infection, low APGAR score in the first minute, and low APGAR score in the fifth minute. From multivariate analysis, gender, gestational age, intrauterine inflammation, and low APGAR score in the first minute were stastically significant. Conclusion: gender, gestational age, intrauterine inflammation, and low APGAR score in the first minute are independent risk factors for early onset neonatal sepsis. Further study is needed to understand the correlation between those factors and early onset neonatal sepsis in preterm infants.

Abstrak :
ABSTRAK
Soluble CD14-ST presepsin merupakan penanda sepsis baru untuk diagnosis dan prognosis sepsis neonatorum. Kadar presepsin meningkat pada keadaan sepsis disebabkan oleh aktivitas protease di fagolisosom. Penelitian ini bertujuan untuk mengetahui manfaat pemeriksaan serial kadar presepsin sebagai penanda pemantauan respons terapi dan prognosis pada pasien SNAL secara bedside dengan menggunakan sampel darah kapiler. Desain penelitian kohort prospektif. Subjek penelitian terdiri dari 20 neonatus sehat dan 42 pasien SNAL. Pemeriksaan kadar presepsin dengan alat Pathfast pada hari ke-1, ke-3, dan ke-6 setelah diterapi. Kadar presepsin pada pasien SNAL 1104 pg/mL (608 ? 6225 pg/mL) lebih tinggi dibandingkan pada neonatus sehat 448 pg/mL (191 ? 513 pg/mL), nilai p 0,000. Pada pasien SNAL kelompok respons terapi kadar presepsin lebih rendah dibandingkan dengan kelompok non respons pada hari ke-3 dan ke-6 (p<0,05). Pada pasien SNAL kelompok non survivor kadar presepsin lebih tinggi dibandingkan dengan kelompok survivor hari ke-6 (p<0,05). Kadar presepsin berkorelasi positif dengan kadar CRP (r=0,488) dan jumlah leukosit (r=0,321). Nilai cut-off kadar presepsin hari ke-6 untuk penentuan prognosis 1365 pg/mL mempunyai AUC 0,789 (IK 95% 0,652 ? 0.926), sensitivitas 90.9%, dan spesifisitas 67,7%. Pemeriksaan presepsin hari ke-3 atau ke-6 secara bedside dengan darah kapiler bermanfaat untuk pemantauan terapi dan prognostik pasien SNAL.ABSTRACT
Soluble CD14-ST presepsin as a new septic marker for diagnostic and prognostic of neonatal sepsis. Concentration of presepsin significantly increases in bacterial sepsis induced by phagolysosome protease activity. The objective of this study is to investigate the prognostic and monitoring value of presepsin in late onset neonatal sepsis (LOS) with serial capillary whole blood assay. This was prosphective cohort, from 20 healthy neonates and 42 LOS patient. The concentration of presepsin was analysed using Pathfast analyzer at 1st, 3rd & 6th day after therapy. Median of presepsin in LOS patient is 1104 pg/mL (608 ? 6225 pg/mL) significantly higher than healty neonates 448 pg/mL (191 ? 513 pg/mL), p value 0.000. Median of presepsin at 3rd & 6th day after therapy in LOS with therapeutic respons is significantly lower than LOS with no respons (p<0.05). Median of presepsin at 6th day after therapy in nonsurvivor is significantly higher than in survivor (p<0.05). There are positive correlation between presepsin and CRP (r=0.488) or leucocyte count (r=0.321). Cut-off presepsin at 6th day after therapy 1365 pg/mL is found with AUC 0.789 (CI 95% 0.652 ? 0.926), sensitivity 90.9%, dan spesificity 67.7%. Presepsin assay at 3rd or 6th day after therapy with capillary whole blood can be used to predict the prognostic and therapeutic respons in LOS patient.;Soluble CD14-ST presepsin as a new septic marker for diagnostic and prognostic of neonatal sepsis. Concentration of presepsin significantly increases in bacterial sepsis induced by phagolysosome protease activity. The objective of this study is to investigate the prognostic and monitoring value of presepsin in late onset neonatal sepsis (LOS) with serial capillary whole blood assay. This was prosphective cohort, from 20 healthy neonates and 42 LOS patient. The concentration of presepsin was analysed using Pathfast analyzer at 1st, 3rd & 6th day after therapy. Median of presepsin in LOS patient is 1104 pg/mL (608 ? 6225 pg/mL) significantly higher than healty neonates 448 pg/mL (191 ? 513 pg/mL), p value 0.000. Median of presepsin at 3rd & 6th day after therapy in LOS with therapeutic respons is significantly lower than LOS with no respons (p<0.05). Median of presepsin at 6th day after therapy in nonsurvivor is significantly higher than in survivor (p<0.05). There are positive correlation between presepsin and CRP (r=0.488) or leucocyte count (r=0.321). Cut-off presepsin at 6th day after therapy 1365 pg/mL is found with AUC 0.789 (CI 95% 0.652 ? 0.926), sensitivity 90.9%, dan spesificity 67.7%. Presepsin assay at 3rd or 6th day after therapy with capillary whole blood can be used to predict the prognostic and therapeutic respons in LOS patient.;Soluble CD14-ST presepsin as a new septic marker for diagnostic and prognostic of neonatal sepsis. Concentration of presepsin significantly increases in bacterial sepsis induced by phagolysosome protease activity. The objective of this study is to investigate the prognostic and monitoring value of presepsin in late onset neonatal sepsis (LOS) with serial capillary whole blood assay. This was prosphective cohort, from 20 healthy neonates and 42 LOS patient. The concentration of presepsin was analysed using Pathfast analyzer at 1st, 3rd & 6th day after therapy. Median of presepsin in LOS patient is 1104 pg/mL (608 ? 6225 pg/mL) significantly higher than healty neonates 448 pg/mL (191 ? 513 pg/mL), p value 0.000. Median of presepsin at 3rd & 6th day after therapy in LOS with therapeutic respons is significantly lower than LOS with no respons (p<0.05). Median of presepsin at 6th day after therapy in nonsurvivor is significantly higher than in survivor (p<0.05). There are positive correlation between presepsin and CRP (r=0.488) or leucocyte count (r=0.321). Cut-off presepsin at 6th day after therapy 1365 pg/mL is found with AUC 0.789 (CI 95% 0.652 ? 0.926), sensitivity 90.9%, dan spesificity 67.7%. Presepsin assay at 3rd or 6th day after therapy with capillary whole blood can be used to predict the prognostic and therapeutic respons in LOS patient.;Soluble CD14-ST presepsin as a new septic marker for diagnostic and prognostic of neonatal sepsis. Concentration of presepsin significantly increases in bacterial sepsis induced by phagolysosome protease activity. The objective of this study is to investigate the prognostic and monitoring value of presepsin in late onset neonatal sepsis (LOS) with serial capillary whole blood assay. This was prosphective cohort, from 20 healthy neonates and 42 LOS patient. The concentration of presepsin was analysed using Pathfast analyzer at 1st, 3rd & 6th day after therapy. Median of presepsin in LOS patient is 1104 pg/mL (608 ? 6225 pg/mL) significantly higher than healty neonates 448 pg/mL (191 ? 513 pg/mL), p value 0.000. Median of presepsin at 3rd & 6th day after therapy in LOS with therapeutic respons is significantly lower than LOS with no respons (p<0.05). Median of presepsin at 6th day after therapy in nonsurvivor is significantly higher than in survivor (p<0.05). There are positive correlation between presepsin and CRP (r=0.488) or leucocyte count (r=0.321). Cut-off presepsin at 6th day after therapy 1365 pg/mL is found with AUC 0.789 (CI 95% 0.652 ? 0.926), sensitivity 90.9%, dan spesificity 67.7%. Presepsin assay at 3rd or 6th day after therapy with capillary whole blood can be used to predict the prognostic and therapeutic respons in LOS patient.

Abstrak :
Sepsis neonatorum awitan lambat (SNAL) masih menjadi penyebab penting kematian dan kesakitan pada bayi kurang bulan. Diagnosis yang cepat penting untuk penatalaksanaan yang sesuai. Diperlukan alat diagnostik yang sederhana, tidak mahal dan cepat hasilnya untuk mendiagnosis SNAL.Tujuan penelitian ini adalah untuk mendapatkan nilai diagnostik rasio netrofil limfosit (RNL) dan kombinasi RNL dan rasio I/T untuk mendiagnosis SNAL. Data penelitian cross sectional ini diambil dari rekam medis pasien bulan januari 2018-Desember 2019 di Divisi Neonatologi Rumah Sakit Cipto Mangunkusumo. Subyek penelitain adalah bayi kurang bulan >30-36 minggu, berusia 7-28 hari dengan klinis sepsis. Dari kultur darah, neonatus dibagi menjadi 2 kelompok, yaitu: proven sepsis dan unproven sepsis. Rasio netrofil limfosit dihitung dari data hitung jenis limfosit. Rasio I/T didapat dari rekam medis. Dari semua 126 subyek penelitian 70 termasuk kelompok proven sepsis dan 56 unproven sepsis. Analisis kurva Receiver operating characteristic RNL didapatkan area under the curve 0.953. Dengan cut off RNL 1.785 didapatkan sensitivitas 78,57%, spesifisitas 92,86%, nilai dugan positif (NDP) 93,22% dan nilai duga negative (NDN) 77,61%. Dengan titik potong rasio I/T > 0,2, didapatkan sensitivitas 55,70 %, spesifitas 83,70%, NDP 81,25% dan NDN 60,26%. Gabungan RNL dan rasio I/T meningkatkan sensitivitas dan NDP rasio I/T berturut-turut menjadi 90% dan 84,44%. Sebagai kesimpulan, RNL dengan titik potong 1,785 mempunyai nilai diagnostik yang baik untuk mendiagnosis SNAL. Kombinasi RNL dan rasio I/T akan meningkatkan nilai diagnostik rasio I/T. ......Late-onset neonatal sepsis (LOS) remains an important cause of death and morbidity among preterm infants. Early diagnostic is important for appropiate management. The simple, inexpensive, and rapid diagnostic tool is required to diagnose LOS. The objective of this study is assesing diagnostic value of NLR and combination of NLR and I/T ratio for diagnosis LOS. The data for this retrospective cross-sectional study was collected from medical record from January 2018 to December 2019 at Neonatology Division Cipto Mangunkusumo Hospital. Preterm infants with >30 -36 gestational weeks, 7-28 days of postnatal age and clinically sepsis were eligible for this study. According to the result of blood cultures, all enrolled infant were classified into 2 groups: proven sepsis and unproven sepsis. The NLR was calculated as the ratio of neutrophil count to lymphocyte count. Immature-to-total neutrophil ratio was taken from medical record. A total of 126 subjects were involved: 70 proven sepsis and 56 unproven sepsis. Receiver operating curve analysis for NLR calculated and area under the curve of NLR corresponded to 0.953. Using a cut off point of 1.785 for NLR, the sensitivity was 78,57%, the specificity was 92,86%, positive predictive value (PPV) 93,22% and negative predictive value (NPV) 77,61%. Using cut off > 0,2, I/T ratio has sensitivity 55,70 %, specificity 83,70%, PPV 81,25% and NPV 60,26%. The combination NLR and ratio I/T increased sensitivity and PPV of ratio I/T became 90% and 84,44%, respectively.As conclusion The NLR with cut off 1,785 has good diagnostic value for SNAL. Combination NLR and I/T ratio can increase diagnostic value of I/T ratio.

Abstrak :
Latar belakang: Persalinan prematur semakin banyak dan memiliki tingkat morbiditas dan mortalitas yang tinggi. Prematur menyumbang angka kematian tertinggi selain asfiksia, infeksi dan kelainan kongenital. Korioamnionitis merupakan salah satu penyebab persalinan prematur dan berhubungan dengan kejadian sepsis neonatal awitan dini pada bayi prematur atau berat lahir rendah. Penelitian dilakukan untuk mengetahui korioamnionitis sebagai prediktor sepsis neonatal awitan dini. Metode : Penelitian kohort prospektif dilakukan bekerja sama dengan Departemen Obstetri dan Ginekologi RSCM dan RSUD Koja. Pengumpulan sampel dilakukan selama periode Maret-September 2022. Dilakukan evaluasi terhadap gejala klinis dan pemeriksaan penunjang ibu yang terkait korioamnionitis, dihubungkan dengan gejala klinis dan pemeriksaan penunjang bayi terkait sepsis neonatal awitan dini yang dirawat di NICU. Hasil : Insidens korioamnionitis sebesar 90% dan sepsis neonatus awitan dini 16%. Jenis persalinan spontan dan section caesarea dengan KPD tidak berhubungan dengan kejadian korioamnionitis (RR:1,049; IK 95% 0,982-1,120; p=1,000) and (RR:1,091; IK 95% 0,967-1,231; p=1,000).Korioamnionitis tidak berhubungan dengan sepsis neonatal awitan dini dengan p=0,358. Demam pada ibu berhubungan dengan kejadian SNAD EONS (RR:3,333: CI 95% 1,399-7,942; p=0,022) Simpulan : Korioamnionitis bukan prediktor sepsis neonatal awitan dini pada bayi usia gestasi ≤32 minggu atau bayi berat lahir ≤ 1500 gram. ......Background: Increasing number of preterm birth correlated with high morbidity and mortality rates. Prematurity contributed in high mortality rates alongside asphyxia, infections and congenital malformations. Chorioamnionitis were associated with preterm birth and early onset sepsis in preterm or low birth weight infants. Research was aimed to determine chorioamnionitis as a predictor of early onset neonatal sepsis (EONS) in preterm or low birth weight. Methodes : Multicentre, Cohort prospective study conducted in collaboration with Obstetrics and Gynaecology Department of Cipto Mangunkusumo National Hospital (CMH) and Koja General Hospital. Samples were obtained in NICU Unit during March - September 2022. Maternal clinical symptoms and diagnostic tests for chorioamnionitis evaluated as a predictor to early onset neonatal sepsis. Results : The incidence of chorioamnionitis and early onset neonatal sepsis were 90% and 16% respectively. Spontaneous and caesarean section delivery with PPROM is not associated with the incidence of chorioamnionitis (RR:1,049; CI 95% 0,982-1,120; p=1,000) and (RR:1,091; CI 95% 0,967-1,231; p=1,000). Chorioamnionitis is not a predictor of early onset neonatal sepsis with p=0,358. Maternal fever is associated with the incidence of EONS (RR:3,333: CI 95% 1,399-7,942; p=0,022). Conclusion : Chorioamnionitis is not a predictor on early onset neonatal sepsis in gestational age ≤32 weeks or birth weight of ≤ 1500 grams.

Abstrak :
Latar belakang: World Health Organization mencetuskan tiga penyebab utama terjadinya kematian neonatal di Indonesia yaitu sepsis, prematuritas dan asfiksia. Lebih lanjut, sebuah studi menemukan bahwa lingkungan rumah sakit yang kurang memadai dapat menjadi risiko terjadinya sepsis neonatal awitan lambat (SNAL) dan dapat memperpanjang masa perawatan. Metode: Data rekam medis dari 1706 neonatus yang dirawat di Divisi Perinatologi Departemen IKA Rumah Sakit Umum Pusat Dr. Cipto Mangunkusumo (RSCM) selama tahun 2020 dikumpulkan secara retrospektif. Didapatkan hanya 262 neonatus yang terbukti mengalami SNAL, dilakukan pencatatan dan analisis usia gestasi, berat lahir dan mikroorganisme penyebab sepsis. Hasil Penelitian: Dari 1706 subyek, insiden SNAL adalah 15,4%. SNAL lebih banyak ditemukan pada kelompok bayi prematur dengan usia gestasi kurang dari 37 minggu (58.4%) daripada kelompok bayi cukup bulan (41.6%). Mayoritas SNAL terjadi pada bayi berat lahir rendah (<2500 gram) yaitu sebanyak 67.6%, dengan persentasi terbanyak terjadi pada kelompok bayi berat lahir rendah (≥1500-<2500 grams) yaitu sebanyak 35.1%. Mikroorganisme penyebab SNAL di RSCM pada tahun 2020 didominasi oleh bakteri gram negatif, yaitu Klebsiella pneumonia, Acinetobacter spp., Escherichia coli, Enterobacter spp., dan Pseudomonas aeruginosa. Kesimpulan: Insiden SNAL pada tahun 2020 adalah 15,4%. Proporsi SNAL pada bayi berat lahir rendah dan bayi prematur secara signifikan lebih tinggi dibandingkan dengan kelompok bayi berat normal dan bayi cukup bulan. Sebagian besar kasus SNAL disebabkan oleh bakteri gram negatif. Adanya mikroorganisme penyebab SNAL yang beragam dari studi ini dapat digunakan sebagai acuan dalam pedoman penggunaan antibiotik empiris di RSCM. ......Introduction: The three main reasons for neonatal death in Indonesia according to WHO are sepsis, prematurity, and asphyxia. A study stated that late-onset sepsis (LONS) was a risk of poor hospital environment and could prolong the duration of hospitalization. Methods: Clinical data from 1706 hospitalized neonates who were treated in the Neonatal Unit in Dr. Cipto Mangunkusumo Hospital (CMH) Jakarta in the year 2020 were analysed retrospectively through medical record. Only 262 neonates that were proven with LONS, and related risk factors such as gestational age, birth weight and microbial in blood stream were analysed.

Results: From a total of 1706 neonates, the incidence of proven LONS was 15,4%. It was more prevalent (58.4%) in preterm neonates aged less than 37 weeks than in term (41.6%) neonates. Majority (67.6%) of proven LONS subjects were neonates with low birth weight (<2500 grams) and the largest percentage between them (35.1%) were in ‘low birth weight (≥1500- <2500 grams)’ group. Gram negative bacteria have emerged as predominant pathogens of LONS patients in our hospital, with most common were Klebsiella pneumonia, Acinetobacter spp., Escherichia coli, Enterobacter spp., and Pseudomonas aeruginosa. Conclusions: The incidence of LONS in 2020 is 15,4%. The proportion of LONS among LBW and preterm neonates is significantly higher compared to normal birth weight and term neonates. Both LBW and NBW neonates, preterm and term neonates suffering LONS in CMH’s neonatal unit are mostly caused by gram-negative bacteria and this finding is statistically significant. Different pathogens causing LONS in this study can be utilized further to analyse the susceptibility of these pathogens to the current empirical antibiotic guideline used in CMH.